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Chronic muscle pain (myalgia) is a common problem throughout the world.

Seemingly simple, it is actually a difficult problem for the clinician interested in determining the aetiology of the pain, as well as in managing the pain.

The two common muscle pain conditions are Fibromyalgia and Myofascial Pain Syndrome.

Fibromyalgia is a chronic, widespread muscle tenderness syndrome, associated with central sensitisation. It is often accompanied by chronic sleep disturbance and fatigue, visceral pain syndromes like irritable bowel syndrome and interstitial cystitis.

Myofascial pain syndrome is an overuse or muscle stress syndrome characterised by the presence of trigger points in muscle.

The problem these syndromes pose lies not in making the diagnosis of muscle pain. Rather, it is the need to identify the underlying causes of persistent or chronic muscle pain in order to develop a specific treatment plan.

Chronic myalgia may not improve until the underlying precipitating or perpetuating factors are themselves managed.

Precipitating or perpetuating causes of chronic myalgia include structural or mechanical causes like scoliosis, localised joint hypo-mobility, or generalised or local joint laxity; and metabolic factors like depleted tissue iron stores, hypothyroidism or Vitamin D deficiency.

Introduction

Physical pain is a common occurrence for many People; in fact, a national survey found that more than one-quarter of U.S. adults had recently experienced some sort of pain lasting more than a day. In addition to conventional treatments, such as over-the-counter and prescription medications, people may try Acupuncture in an effort to relieve pain. This fact sheet provides basic information about pain and acupuncture, summarizes scientific research on acupuncture for specific kinds of pain, and suggests sources for additional information.

Key Points

People use acupuncture for various types of pain. Back pain is the most commonly reported use, followed by joint pain, neck pain, and headache.

Acupuncture is being studied for its efficacy in alleviating many kinds of pain. There are promising findings in some conditions, such as chronic low-back pain and osteoarthritis of the knee; but, for most other conditions, additional research is needed. The National Center for Complementary and Alternative Medicine (NCCAM) sponsors a wide range of acupuncture research.

Acupuncture is generally considered safe when performed correctly.

In traditional Chinese medicine theory, acupuncture regulates the flow of qi (vital energy) through the body. Research to test scientific theories about how acupuncture might work to relieve pain is under way. Continue reading Acupuncture studies by NCCAM

IF YOU have ever absent-mindedly rubbed your eyes or nose after chopping up chilli peppers, you’ll have some idea of the suffering of one group of scientists in the name of medical research. A team at the Institute of Neurology in London have been injecting chilli juice into each others’ foreheads. Lab technician Paul Hammond, who got roped into the experiment, says it felt like acid was burning into his skin. “It was one of the most excruciating pains you can imagine,” he recalls.

The researchers weren’t sadomasochists, as far as we know. Their actions were part of a much larger research effort that has been shedding light on migraine. For although in the past few decades we have learned a great deal about the condition, we still have no idea of its root cause. And while we have drugs that help some patients, some of the time, understanding the underlying defect is the best way to boost our chances of discovering a sure-fire cure.

Originating in ancient China, Acupuncture has been used for 2500 years. Traditional Chinese medicine holds that disease is caused by blockages and imbalances of energy (known as chi) flowing through meridians in the body, and can be eased by inserting needles at specific points.

Since the 1970s, Acupuncture has become more popular outside east Asia. Once widely considered a quack medicine, there is now tentative support for its use in certain conditions from respected official bodies such as the World Health Organisation, the National Health Service in the UK and the National Institutes of Health in the US.

There is evidence that Acupuncture is effective in treating a range of conditions including spinal injuries, back & neck pain, migraine headaches, infertility and the side effects of chemotherapy , and that its effects aren’t entirely due to the placebo effect. Recent research is now showing why Acupuncture works.

Wenjing Huang of Charité University Medical Center, Berlin, Germany, and colleagues used more than 100 studies to produce these brain maps of 18 acupuncture points. Areas of the brain activated by stimulating a point are shown in red; areas deactivated are shown in blue.

For example, the two vision-related points GB37 (gall bladder) and UB60 (urinary bladder) showed deactivation in visual brain areas like the Cuneus. The team concluded that Acupuncture seems to affect the brain’s processing of both physical Sensations and Emotions. For now, though, the source of Chi remains elusive.

A HAIR-THIN needle pricks the skin. What happens next depends on who you ask. A traditional Chinese practitioner will tell you that acupuncture manipulates the body’s vital energy, Qi (pronounced chee), balancing the opposing forces of Yin and Yang. When Yin and Yang are in harmony, Qi flows freely along pathways called meridians and you stay healthy, but when the Qi gets blocked you become ill. Inserting needles into points along a meridian unblocks Qi and restores the body’s healthy balance.

Western scientists explain it differently. They say inserting needles at acupuncture points stimulates the nervous system to release morphine-like substances that block pain signals. It may also trigger neurotransmitters and neurohormones, which influence such dynamic systems as circulation and the immune response. Continue reading Acupuncture: East & West

Pain can be a very useful warning signal. Hit your thumb with a hammer and this stimulates pain receptors in the skin, a signal is sent to the brain, and it hurts. The natural reaction is to bandage the thumb, where – upon the pain subsides. But this picture does not tie in well with something like long-term joint pain, which is one of the most common pain conditions. Joint pain often starts when pain receptors are stimulated by inflammation, but even once all signs of the inflammation have gone, something often continues to cause pain – the question is what ?

“The inflammation activates the pain nerves, and in some cases this eventually leads to something changing in the actual pain system so that the pain persists, and it’s this change that we’re trying to understand,” says Camilla Svensson, a researcher at Karolinska Institute’s Department of Physiology and Pharmacology in Stockholm, Sweden.

We now know that between the pain receptors and the brain are a number of relay stations which all affect the final perception of pain. Camilla Svensson’s research focuses on the interplay between the inflammation in the joint and activity at the first relay station, where chemical messengers transmit the pain signal from the peripheral nerves to the neural pathways in the spinal cord. Continue reading Developments in Pain Research

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JON LEVINE was just testing painkillers on people who’d had a wisdom tooth extracted, when he uncovered rather more than he’d bargained for. The women in his study group found that strong painkillers related to morphine, called kappa-opioids, were most effective at numbing pain. But the same drugs didn’t work for the men at all. “In fact, the doses used in the clinical trial made pain worse for men,” says Levine, a clinical neuroscientist from the University of California in San Francisco.

He was shocked. “The idea that a therapy that had been around for decades could affect women and men in such dramatically different ways was anathema,” he says. “It was such an incredible mindset in the field of pain, missing what had clearly gone on in front of their eyes for years.” Continue reading His Pain : Her Pain